What Is the risk of anastomotic leak after repeat intestinal resection in patients with Crohn’s?

The most recent issue of the Diseases of the Colon & Rectum investigates the risk of anastomotic leak after repeat intestinal resection in patients with Crohn’s disease.

Approximately half of Crohn’s patients require intestinal resection, and many need repeat resections.

Dr Forrest Johnston and colleagues evaluated the increased risk of clinical anastomotic leak in patients with a history of previous intestinal resection undergoing repeat resection with anastomosis for Crohn’s disease.

The team performed a retrospective analysis of prospectively collected departmental data with 100% capture.

The team conducted a study at the department of colorectal surgery in a tertiary care teaching hospital between 2007 and 2016.

Patients with 1 previous resection had a leak rate of 13%

Diseases of the Colon & Rectum

A cohort of consecutive patients with Crohn’s disease who were treated with intestinal resection and anastomosis, excluding patients with proximal fecal diversion, were included.

The researchers reported that the cohort was divided into 2 groups, those with no previous resection compared with those with previous resection.

The team's main outcomes included clinical anastomotic leak within 30 days of surgery.

Of the 206 patients who met criteria, 40% of patients had previous intestinal resection.

The research team found that the 2 groups were similar in terms of patient factors, immune-suppressing medication use, and procedural factors.

Overall, 20 clinical anastomotic leaks were identified.

The researchers detected 5% of leaks in patients with no previous intestinal resection and 17% of leaks in patients with a history of previous intestinal resection.

The team noted that the odds ratio of anastomotic leak in patients with Crohn’s disease with previous resection compared with no previous resection was 3.5.

Patients with 1 previous resection had a leak rate of 13%, whereas patients with ≥2 previous resections had a leak rate of 23%.

The team observed that the number of previous resections correlated with increasing risk for clinical anastomotic leak.

Dr Johnston's team comments, "Repeat intestinal resection in patients with Crohn’s disease is associated with an increased rate of anastomotic leakage when compared with initial resection despite similar patient, medication, and procedural factors."